Random urine drug testing among patients receiving opioid therapy for cancer pain

Abstract

Background There is limited information regarding the true frequency of nonmedical opioid use (NMOU) among patients receiving opioid therapy for cancer pain. Data to guide patient selection for urine drug testing (UDT) as well as the timing and frequency of ordering UDT are insufficient. This study examined the frequency of abnormal UDT among patients with cancer who underwent random UDT and their characteristics. Methods Demographic and clinical information for patients with cancer who underwent random UDT were retrospectively reviewed and compared with a historical cohort that underwent targeted UDT. Random UDT was ordered regardless of a patient's risk potential for NMOU. Targeted UDT was ordered on the basis of a physician's estimation of a patient's risk for NMOU. Results In all, 552 of 573 eligible patients (96%) underwent random UDT. Among these patients, 130 (24%) had 1 or more abnormal results; 38 of the 88 patients (43%) who underwent targeted UDT had 1 or more abnormal results. When marijuana was excluded, 15% of the random group and 37% of the targeted group had abnormal UDT findings (P < .001). It took a shorter time from the initial consultation to detect 1 or more abnormalities with the random test than the targeted test (median, 130 vs 274 days; P = .02). Abnormal random UDT was independently associated with younger age (P < .0001), male sex (P = .03), Cut Down, Annoyed, Guilty, and Eye Opener–Adapted to Include Drugs positivity (P = .001), and higher Edmonton Symptom Assessment System anxiety (P = .01). Conclusions Approximately 1 in 4 patients receiving opioids for cancer pain at a supportive care clinic who underwent random UDT had 1 or more abnormalities. Random UDT detected abnormalities earlier than the targeted test. These findings suggest that random UDT is justified among patients with cancer pain.

Management of pain in the cancer patient

“…Opioids, while widely feared due to the association with misuse and addiction are essential due to their effectiveness in managing cancer pain. There is now mounting evidence that patients with cancer who receive opioids might be at a higher risk NMOU than previously believed, ( 59 , 60 ) with one in five cancer patients at risk ( 61 ). Therefore, clinicians need to be mindful of the risks of misuse in cancer patients as well and assume responsibility for risk management even when these drugs are being legitimately prescribed.…”

Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain

“…There have been efforts by clinical teams to develop programs and enhance strategies to manage patients who engage in NMOU. [28][29][30][31] Isolated strategies such as use of risk assessment tools, 17,32,33 prescription monitoring programs, 34 Urine Drug Screens, [35][36][37][38][39][40] and closer observation 5,21 have been used. However, the reach of these individual strategies is limited, and there are no comprehensive clinical interventions to manage this extremely complex and rapidly growing population.…”

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

“…Chronic opioid therapy requires careful periodic evaluations and revisions in the light of the patient's response to ongoing treatments, adverse effects, risk for nonmedical opioid use (NMOU), and other clinical findings. Recent reports indicate that NMOU is more common among cancer patients receiving opioid therapy than was previously thought 4,5 . Clinical teams in oncology settings continue to develop innovative and effective strategies to manage patients who engage in those behaviors 6 .…”

“…A study by our group found that approximately 1 in every 4 patients receiving chronic opioid therapy for cancer pain had an abnormal UDS concerning for NMOU. 4 In another study, clinicians felt that 18% of patients with advanced cancer that they saw were chemically coping. 17 Screening for NMOU among cancer patients is now even more critical during the COVID-19 crisis because the risk is heightened by stressful conditions.…”